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health sector

Healthcare

There is a Municipal Hospital at Saltpond as well as a public sector run health center at Anomabo. Other health care facilities are privately run and these can be found at Mankessim, Saltpond, Anomabo, Abor Junction, Otuam and Essuehyia.
HEALTH FACILITIES IN THE MUNICIPALITY(2010-2013)

 Government Health Facilities
 SALTPOND GOVERNMENT HOSPITAL
 ANOMABO HEALTH CENTRE
DOMINASE HEALTH CENTRE
 MANKESSIM HEALTH CENTRE
 ESSUEHYIA HEALTH CENTRE
OTUAM HEALTH CENTRE
BIRIWA COMMUNITY CLINIC
NANABEN CHPS
NARKWA CHPS
EDUMAFA CHPS
EKUMPOANO CHPS
TAIDO CHPS
NSANFO CHPS
EBUAKWA COMMUNITY CLINIC
SRAFA KOKODO CLINIC
Private health facilities
PRINCE CHARLES HOSPITAL-MANKESSIM
FYNNBA HOSPITAL- MANKESSIM
PEACE CLINIC-MANKESSIM
BETHEL HOMEOPATHIC CLINIC-ESSUEHYIA
GOD’S GIFT MATERNITY- EKUMFI
ST. ANTHONY MATERNITY HOME-MANKESSIM
ST. JUDE BLESSING CLINIC

Ghana Health Service Vision
We envision people living in Ghana live longer, and are healthier, wealthier and happier.
Ghana Health Service Mission
To provide quality health service responsible to the needs of all persons living in Ghana by implementing approved health sector policies, increase access to priority health services and manage prudently resources available for provision of health services.

OUTLOOK/ PRIORITIES FOR 2009
The municipal health directorate key priorities for 2009 are as follows:
•    Reduction of institutional maternal mortalities by 50% through strengthening collaborative efforts with key stakeholders, strengthening referral systems and enhancing blood availability at the municipal hospital.

•    Reduction of institutional and community childhood mortalities by 25%, through strengthening of quality institutional care, effective implementation of IMCI/ clinical protocol and achieving national/ regional targets for immunization.

•    Reduction of communicable disease burden by 25% through intensified health education, talks, proper environmental practices, adopting effective health interventions and instituting effective disease surveillance and responses.

•    Improving of clients patronage of  health facilities by 25%, by  improving quality of clinical care, addressing clients concerns and building basic laboratory services at three sub districts
•    Improving access to health care through intensified education on NHIS registration advantages, especially in the Ekumfi, Otuam and Abeadze Dominase catchment areas and starting the CHPS concept in two catchment communities.

•    Improving on health staff motivation by establishing motivational packages, seeking accommodation for staff and instituting a yearly award scheme.

•    Strengthening monitoring and supervision for all health staff and health facilities at every quarter , by developing action plans and appropriate checklists

•    Ensuring sound financial and procurement practices by adhering to established regulations governing GHS, and responding promptly to all audit queries.

•    Strengthening data management practices, ensuring timely reports submission conducting appropriate surveys and operational researches and disseminating findings to inform decisions making.

•    Strengthening collaborative efforts with all key health partners and stakeholders by addressing their concerns, engaging in regular dialogues and feedbacks and involving them in health programmes




HUMAN RESOURCE
The Human Resource department of the Mfantseman Municipal Health Directorate exists to see to the general welfare of health staff at the Directorate and facility level.

The department has also been charged to implement policies, inform staff on current issues, plans and programmes from the National, Regional and the Municipal level. It also ensures building and maintains accurate and efficient human resource data for improving and strengthening staffing situation to improve health delivery system in the municipality

STAFFING SITUATION

The total number of staffs of the Mfantseman Municipal Health Directorate as at the end of December 2009 stood at 277 this includes 16 new staff entrants, 7 staff transferred in,8 staff transferred out 14 on study leave. Four staffs vacated their post during the period.

Table 3:StaffsCategory

Category                               Number
MEDICAL OFFICERS                   4
MEDICAL ASSISTANTS                6
MIDWIVES                              22
STAFF NURSES                        25
PHARMACIST                            1
HEALTH AIDES                         21
TECHNICAL OFFICERS                5
PUBLIC HEALTH NURSES             3
COMMUNITY HEALTH NURSES    44
FIELD TECHNICIANS                   4
HEALTH EXTENSION                  46
CASUALS                                25
MEDICAL OFFICERS                   4
MEDICAL ASSISTANTS                6
MIDWIVES                              22
STAFF NURSES                        25
PHARMACIST                            1
HEALTH AIDES                        21
TECHNICAL OFFICERS               5
PUBLIC HEALTH NURSES              3
COMMUNITY HEALTH NURSES     44
ACCOUNTANT                            3
DRIVERS                                   5
WARD ASSISTANTS                   14
ORDERLIES                              19
EXECUTIVE OFFICER                   2
ACCOUNTANT                            3
DRIVERS                                   5
WARD ASSISTANTS                   14
ORDERLIES                              19


DISEASE CONTROL

Malaria

Malaria continues to be the leading cause of disease episode in the municipality with 55,741 cases representing 61.7 % of all cases seen at the health facilities. Malaria cases seen among under five year children has also increase from 10,336 to 13,241 in 2008 and 2009 respectively

HIV/AIDS
The current status of HIV /AIDSin the Mfantseman Municipality is shown in the table below:

Table 4:    Status of   HIV /AIDS

Age        2007        2008        2009
0-9          4             7             5
10-19      4              8            14
20-29      44            78           102
30-39      75            80           103
40-49      20            40           68
50-59      10            13           21
60+        10               3            7
Total       167          229          320


The year 2009 has record 320 cases of HIV which is an increase over the previous years.
The high number of cases of HIV diagnosed is attributed to improvement in Prevention of Mother to Child Transmission of HIV/AIDS (PMTCT) services, Voluntary counseling and testing (VCT) and Know Your Status Campaigns conducted in the municipality. There is the need for intensification of education on responsible people’s sexual behavior

Cases of Tuberculosis
The table below indicate the trend of  cases of tuberculosis in the Municipality

Table 5: Trend of Tuberculosis

Indicator                        2007        2008        2009
no. of new TB cases    M    132        69                61
                                        45        32
                                F           
Total cases                      132        114              93

No. of defaulters                  1          2                 -
No. of deaths                     14         17                -
No. of failures                      5          5                 -
No. cured                           96          76               -


Total number of 93 new TB cases were seen over the period (2009) among which 61 were males and 32 females. Compared with last two years there has been decreases in the number of cases reported



EXPANDED PROGRAMME ON IMMUNIZATION (EPI)

Statistics from EPI activities indicates targets (90%) for 2009 in all the antigens has been achieved even though there were slight decreases from the previous two years
 
Table 6:    Immuninization Trend
               
                  2007(%)           2008(%)           2009(%) 

ANTIGEN
     
 BCG             123                119                  111.1
 MEASLES        95                103                    93.1
 PENTA 3         96                 96                     92.5
 POLIO3          96                96                     92.5
 YELLOW FEVER94                99                     93.1
 TT2+             95                99                     84.0



LIFESTYLE DISEASES

Lifestyle diseases such as hypertension, diabetes mellitus, anaemia, and severe acute mal-nutrition (SAM) are on the increases in the municipality and this is a major public health concern.
Table 7:  Lifestyle Diseases

DISEASES                    2007      2008       2009

DIABETES MELLITUS     140        246            831
HYPERTENSION            950        1,305      4,051
ANAEMIA                     250        1,205      1,585
SEVERE ACUTE
MALNUTRITION             3          10             35

Hypertension cases shot up from 950 cases in 2007, 1305 cases in 2008 to 4051 cases in the year 2009. There is also an increase in severe acute malnutrition cases from 3 in 2007, 10 in 2008 to 35 in 2009.


REPRODUCTIVE AND CHILD HEALTH (RCH)

The RCH department takes care of reproductive and child health issues. These include family planning, antenatal care, deliveries, post-natal care, school health, child health etc.
Antenatal care coverage has dropped slightly for 99% in 2007, 104% in 2008 to 94% in 2009.
Teenage pregnancies has also been of major concern, fortunately there is a drop in the trend ,17.2,15.2 and 14.5 in 2007,2008 and 2009 respectively.
Coverages for Intermittent Preventive Treatment which is intended to protect pregnant women against malaria has dropped to 32.1 percent from 34 percent in 2008.

Table 8:    Trend of Delivery and Post-Natal Care Indicators
 
    INDICATOR                    2007            2008              2009

SKILLED DELIVERIES (%)      34.0            41.2              42.5
   TBA DELIVERIES (%)         36.3            28.0              15.7
  INST. STILLBIRTHS (%)       3.7              2.6               2.9
  INST.LBW BABIES (%)        15.1              5.8                7.3
   MATERNAL DEATHS               3               6                   2
 CAESAREAN SECTION (%)     6.4               5.6                8.4
 POSTNATAL REGISTRANTS (%)68.6         64.7               62.2
 
Fortunately in 2009, Mfantseman witness only two (2) maternal deaths as against six (6) in 2008
Institutional deliveries have increased slightly from 41.2 in 2008 to 42.5 in 2009.

FAMILY PLANNING

Family planning acceptor rate has dropped from 25.6 %, 20.2 % to 19.2% in 2007, 2008, and 2009 respectively. Long term method such as Bilateral Tubal Ligation (BTL) has increased from 23 to 39 in 2008 and 2009.

Table 9: Family Planning Method

    METHOD                 2007               2008        2009
Male Condom              2700              1765        1687
Female Condom          58                  89             70
Combined Pill              1044              1423         857
Mini- Pill                      59                 49            25
IUCD                          34                 59            55
Injectables                 3752               3536        4739
BTL                            24                  23             39
Norplant/Jadelle           30                 72            152
LAM                         3451                1867         319
FP ACCEPTOR RATE        25.6            20.2         19.2


INSTITUTIONAL CARE (CLINICAL)

Table 10: Top Ten Causes of OPD Attendance


DIAGNOSIS                            NO                 %

Malaria                                 54,779          61.7
acute resp. tract infection         4,881            5.5
hypertension                          4,237            4.8
diarrhea infections                  3,652            4.1
skin infections                        3,150            3.5
Anaemia                                1,529            1.7       
Rheumatism                          1,205            1.4
Malarial in pregnancy                 960            1.1
Intestinal worms                       905             1.0
Home  accidents/injuries            901             1.0
Others                                12,611            14.2

Malaria continues to be the leading cause of OPD attendance constituting 61.7 percent. Acute Respiratory Tract Infection, Hypertension Diarrheal diseases, skin infections anemia rheumatism, malaria in pregnancy, intestinal worms, home accidents and injuries followed in that order on the top ten table.

Table 11: Key Clinical Performance Indicators

       INDICATOR                  2007                 2008              2009
 
OPD Attendance                69,412                104,686           117,847
Total admissions                 5983                  6,679             6,799
Total deaths                          257                    278               227

No. of Major & Minor surgeries   689                    764               796
No. of inst. Infant admissions   523                    536               442
No. of inst. Infant deaths           51                     53                35
No. of  inst. U5 admissions       1151                  1364              1262
No. of  inst. U5  deaths             82                        74                58
OPD Per Capita                        0.4                    0.6               0.6

OPD attendance shot up to 117,847 in 2009 with OPD per capita of 0.6.Total institutional deaths has drop deaths to 227 in 2009 against 278 in 2008


Table 12: Top Ten causes of Institutional Deaths

 CONDITION           NO      %

MALARIA                42      18.5
ANAEMIA                38      16.5
CVA                       27      9.4
HYPERTENSION        21      9.3
NEONATAL SEPSIS    12      5.3
PNEUMONIA             8       3.3
SEPTICAEMIA            6      2.7
GASTROENTERITIS    6      2.7
ACUTE ABDOMEN       5      2.0
DIABETES                 5      2.0
OTHERS                   57     28.0

 TOTAL                  227     100
 
Malaria contributed 18.5 percent of all institutional death, followed by Anemia and Cardio-vascular Accident (CVA) with 16.5 and 9.4 percent respectively.


2009 ACHIEVEMENTS
•    Institutional hospital admissions for infants and U5s dropped
•    Institutional infant and U5s deaths dropped from 10% to 8% and 5.4% to 4.6% resp.
•    Institutional maternal deaths dropped from 6 to 2 i.e. 67%.
•    Skilled deliveries increased slightly and TBA deliveries dropped.
•    Strengthened disease surveillance activities and have developed an epidemic prep. Plan
•    Started Anti-retroviral therapy clinic for PLWHAs
•    EPI Coverages encouraging.
•    Major renovation works done at the Municipal Hospital
•    TB Shed construction at Hospital near completion
•    One Maternal and Nutritional Rehabilitation Centre at Ekrofu- HFFG
•    Two municipal-wide monitoring and supportive supervision visits to all health facilities
•    Reconstituted committees and management meeting are organized more frequently
•    Developed and disseminated a 5- YEAR STRATEGIC PLAN to all key stakeholders
•    Conducted one municipality-wide client/staff satisfaction survey- encouraging results
•    Established an EYE UNIT at the Municipal Hospital

•    One ambulance donated to the MHD BY AMICUS ONLUS

MAJOR CHALLENGES
•    Malaria, HIV/AIDS and diarrheal cases with deaths rising
•    Hypertension and diabetes cases high
•    Stillbirths and neonatal deaths high
•    Severe acute malnutrition in U5 children common
•    Family planning acceptor rate low
•    High patronage of spiritual gardens and prayer camps
•    Delays in NHIS Claims reimbursements
•    Absence of sub-district laboratory services
•    Inadequate numbers of all categories of health staff
•    Lack of staff residential accommodations across the municipality.
•    Lack of mortuary and dental units at the Municipal Hospital.
•    Lack of vehicles for regular administrative, monitoring and supervision visits to health facilities.
•    Lack of appropriate office accommodation for the municipal health directorate.


RECOMMENDATION

•    Strengthening health educational campaigns at all levels of care on Malaria/HIV prevention, healthy lifestyles, EBF/ACF and use of family planning services by the MHD
•    Increase the coverage and use of health commodities ie ITN’s, Condoms, Vit.A, SP and vaccines by the MHD
•    Improve on monitoring in labor and use of partographs by practicing midwives
•    Embark on blood donation campaigns and consumption of nutritious food by MHD
•    Appropriate care for all neonates by practicing midwives and TBAs.
•    MHD to Strengthen collaboration with heads of all prayer camps and spiritual gardens
•    NHIA expedite action on measures to speed up payment of claims to all health facilities.
•    NGOs and corporate bodies to assist in the establishment of laboratory units at sub-municipal health centres.
•    MOH/GHS streamline and strengthen training, recruitment and retention of health staff.
•    The Municipal Assembly and local traditional authority assist in the provision of staff residential accommodations.


WAY FORWARD/PRIORITIES FOR 2010

•    Operationalize two CHPS compounds at Eyisam and Immuna.
•    Strengthen quality assurance practices to ensure quality of health        services
•    Strengthen behavioral change communication and improve on health commodities coverages
•    Establish laboratory units at Anomabu, Abeadze Dominase,and Essuehyia health centres.
•    Lobby for the construction of ANC shed and Mortuary Unit at the Hospital.
•    Strengthen book-keeping stores management practices at the sub-municipal level.
•    Conduct operational researches to inform decision-making at the municipal level
   

Refer to table in pdf file below.


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